Endometrial and placental parallels of morphological and immunohistochemical changes in women with hyperproliferative diseases of the uterus

The role of endometrial pathology in placentation disorders and the development of pregnancy complications is undeniable. After all, it is the adequate morphofunctional state of the endometrium is one of the main factors that perform successful implantation of a fertilized egg and embryo development.The objective: to study the morphological and immunohistochemical (IHC) features of the endometrium in women with hyperproliferative diseases of the uterus (HPDU) and the placenta in these same women after personalized treatment before pregnancy.Materials and methods. Morphological and IHC features of the endometrium before pregnancy were studied in 54 women with HPDU (main group) of reproductive age and the placenta in these same women after childbirth. Of these, 43 women after personalized treatment before pregnancy due to the endometrium changes and according to the diagnosis of HPDU, after the onset of pregnancy, which ended in term labor (1 group) and 11 women who did not have pre-pregnancy preparation and whose pregnancy ended in premature labor (2 group).On days 6–9 of the menstrual cycle, hysteroscopy was performed using Karl Storz equipment (Germany) according to strict clinical indications, the main of which was suspicion of uterine endometrial pathology. Thus, the patients of reproductive age who were in the department of rehabilitation of women’s reproductive function of the SI “Ukrainian Center of Maternity and Childhood of NAMS of Ukraine” were examined. Morphological and IHC examination of the endometrium and placentas was performed: determination of estrogen receptor (ER) and progesterone receptor (PR) markers, hematopoietic stem and progenitor cell marker CD34, vascular endothelial growth factor VEGF, proliferation factor – Ki-67 protein, mesenchymal factor vimentin and anti-apoptotic antigen Bcl-2. IHC examination was performed using an Olympus BX51 microscope (Japan).Results. Endometrial pathology was detected in all patients with HPDU. 20 (37.0%) of the examined women had combined endometrial pathology. High expression of steroid receptors for estrogen and progesterone in the nuclei of glandular epithelial cells was found. Strong expression of VEGF and Vimentin was determined in the cell wall of the glands and endometrial stroma and Ki-67 in the endometrial stromal cells in women of the main group. Morphological and IHC study of placentas indicates compensatory reactions in women of the 1 group, which is manifested by different expression of Vimentin and VEGF in all placentas in the syncytia of villus and endothelium of some vessels of the middle villi compared to placentas of the 2 group. Lower expression of CD34 was found in the villous chorion of the placenta of women of the 2 group.Conclusions. In the endometrium of women with HPDU the changes in proliferative activity and cell cycle regulation were found, which gave grounds for a more accurate choice of treatment approach before pregnancy, which is confirmed by compensatory changes in the placenta in patients who received treatment.